Provider Demographics
NPI:1306959648
Name:KILFOIL, PETER J (DPM)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:KILFOIL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1343
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-0964
Mailing Address - Country:US
Mailing Address - Phone:631-765-5600
Mailing Address - Fax:631-765-2374
Practice Address - Street 1:53345 MAIN RD
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-4643
Practice Address - Country:US
Practice Address - Phone:631-765-5600
Practice Address - Fax:631-765-2374
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003001213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
493890OtherUNITED HEALTH CARE
NY00420842Medicaid
NY480034225OtherRAILROAD MEDICARE
NYP32632OtherEMPIRE BLUE CROSS AND BLUE SHIELD
493890OtherUNITED HEALTH CARE
NYA300001156Medicare PIN
NYP32632OtherEMPIRE BLUE CROSS AND BLUE SHIELD
NYP32632Medicare PIN